Left Ventricular and Atrial Function in Patients with Isolated Mitral Annular Calcification.

Abstract

Background: Evaluation of left ventricular (LV) and left atrial (LA) function using Doppler echocardiography in patients with mitral annular calcification (MAC) is challenging. This study aimed to determine the clinical significance of LV and LA function using speckle-tracking echocardiography in patients with isolated MAC.

Methods: Among 537 patients with MAC identified by echocardiography during 2012-2016, 275 (73.7 ± 11.0 years, 63.6% women) without atrial fibrillation, other severe valve disease, or mitral regurgitation were retrospectively analyzed. The LV global longitudinal strain (GLS) and LA strain were measured using vendor-independent software. The primary outcome was the composite of cardiovascular death and heart failure admission.

Results: During a median follow-up of 42.0 (interquartile range, 7.6-87.9) months, 34 events occurred. Patients with events had lower absolute values of LV-GLS and LA reservoir strain than those without events. LV-GLS and LA reservoir strain worsened as MAC increased in severity. When patients were stratified into four groups according to LV-GLS and LA reservoir strain, the numbers of events were significantly different (log-rank P = 0.005). Following multivariable adjustment, LV-GLS (adjusted hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.12-1.38; P < 0.001) and LA reservoir strain (adjusted HR, 0.86; 95% CI, 0.80-0.92; P < 0.001) were independently associated with higher incidence of composite outcomes. LV-GLS and LA reservoir strain had incremental value for predicting composite outcomes over clinical variables and the mitral E to A ratio.

Conclusion: Assessing LV-GLS and LA reservoir strain in patients with MAC is useful for predicting adverse outcomes.